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Kidney Week

Abstract: TH-PO166

Impact of an EHR Alert on SGLT2 Inhibitor Use in Patients with Type 2 Diabetes (DM2) and CKD

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Park, Ken J., Kaiser Permanente Northwest, Portland, Oregon, United States
  • Cruz, Maria Carren R., Kaiser Permanente, Oakland, California, United States
  • Nakashimada, Lisa J., Kaiser Permanente, Oakland, California, United States
  • Albright, Eric S., Kaiser Permanente Northwest, Portland, Oregon, United States
Background

SGLT2-inhibitors have been shown to reduce the risk of progression to ESRD in patients with CKD. Both KDIGO and ADA strongly recommend that all patients with CKD and DM2 should be prescribed an SGLT2-inhibitor. However, SGLT2-inhibitors remain under prescribed, especailly amongst non-nephrologists. We implemented a quality improvement project to increase SGLT2-inhibitor prescribing and to narrow the gap between nephrologists and non-nephrologists by developing an EHR alert recommending SGLT2-inhibitors at time of patient visit.

Methods

This was a quality improvement project in which an EHR alert targeting patients with DM2 with last eGFR between 30 and 60 ml/min and last ACR > 300 was rolled out on 6/22/2022. Inclusion criteria for the EHR alert were age 18-85, CKD G3 with last eGFR between 30-59 ml/min, most recent ACR > 300 mg/gm or PCR > 0.5 within past 12 months, and on ACEi or ARB or intolerance. Data was deidentified and collected cross sectionally monthly from a diabetes registry and reviewed quarterly. We tracked SGLT2 inhibitor use within 1 year of index date. SGLT2-inhibitor use was compared to patients with eGFR > 60 ml/min with ACR > 300 mg/gm who were not included in the EHR alert.

Results

Prior to the EHR alert, SGLT2 inhibitor was prescribed at a higher rate in patients managed by nephrology vs. patient not managed by nephrology (28.5% vs. 10.7%). By 8 months after its rollout, this gap had increased further (44.5% vs. 16.3%). Prior to EHR alert, SGLT2 inhibitors were prescribed in 18.6% of patients with eGFR between 30 to 60 ml/min and ACR > 300 mg/gm vs. 10.2% in patients with eGFR ≥ 60 ml/min and ACR > 300 mg/gm. By 8 months afterwards, this had increased to 32% and 15.7% respectively. Amongst patients not followed by nephrology, SGLT2 inhibitor was prescribed in 13% of patients with eGFR between 30 to 60 ml/min and ACR > 300 mg/gm vs. 9.4% in patients with eGFR ≥ 60 ml/min and ACR > 300 mg/gm prior and 23.6% vs. 13.3% by 8 months after the EHR alert.

Conclusion

We saw a greater increase in SGLT2 inhibitor prescribing in patients with CKD targeted by an EHR alert compared to patients not targeted by an EHR alert. However, overall SGLT2 prescribing remained low and we were unable to close the gap between patients managed and not managed with nephrology.